Appropriateness of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans to measure preoperative anxiety and the effect of preoperative anxiety on postoperative quality of recovery

Background@#The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. @*Methods@#Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. @*Results@#There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett’s test of sphericity was < 0.001. Cronbach’s alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). @*Conclusions@#The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.

Changes in the Perception Structure of the Concept of Empathy According to the Educational Experience of Medical Students / 의료커뮤니케이션

Purpose@#: The purpose of this study is to explore changes in the conceptual perception structure of medical students’ empathy according to the educational experience provided at the beginning of the basic medical education. @*Methods@#: The subjects of this study were 116 students in the 2nd year of the pre-medical department of the College of Medicine. @*Results@#: Before and after the basic medical interview class and after the end of the dissection practice, words included in the concept of empathy such as ‘the other person’, ‘emotion’, ‘understanding’, ‘position’, ‘situation’, and ‘thought’ appeared in common. However, these common words appeared mixed before and after the basic medical interview class, but after the end of the dissection practice, they changed to a structure that recognizes the concept of empathy by integrating the core concepts of ‘the other’, ‘understanding’, and ‘emotion’. In particular, after the end of the dissection practice, the word ‘patient’ appeared, expressing the specific object of empathy as a doctor for the first time. @*Conclusion@#: Curriculum related to medical interview within the basic medical education curriculum should be systematically developed so that students can continuously experience practical medical interview situations along with theoretical education.

Changes in the accreditation standards of medical schools by the Korean Institute of Medical Education and Evaluation from 2000 to 2019 / 보건의료교육평가

This review presents information on changes in the accreditation standards of medical schools in Korea by the Korean Institute of Medical Education and Evaluation (KIMEE) from 2000 to 2019. Specifically, the following aspects are explained: the development process, setting principles and directions, evaluation items, characteristics of the standards, and validity testing over the course of 4 cycles. The first cycle of accreditation (2000–2005) focused on ensuring the minimum requirements for the educational environment. The evaluation criteria emphasized the core elements of medical education, including facilities and human resources. The second cycle of accreditation (2007–2010) emphasized universities’ commitment to social accountability and the pursuit of excellence in medical education. It raised the importance of qualitative standards for judging the content and quality of education. In the post-second accreditation cycle (2012–2018) which means third accreditation cycle, accreditation criteria were developed to standardize the educational environment and programs and to be used for curriculum development in order to continually improve the quality of basic medical education. Most recently, the ASK 2019 (Accreditation Standards of KIMEE 2019) accreditation cycle focused on qualitative evaluations in accordance with the World Federation of Medical Education’s accreditation criteria to reach the international level of basic medical education, which emphasizes the need for a student-centered curriculum, communication with society, and evaluation through a comprehensive basic medical education course. The KIMEE has developed a basic medical education evaluation and accreditation system in a step-by-step manner, as outlined above. Understanding previous processes will be helpful for the future development of accreditation criteria for medical schools in Korea.

Squamous Cell Carcinoma Arising in an Amputation Stump / 대한피부과학회지

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.

Effects of medical communication curriculum on perceptions of Korean medical school students / 한국의학교육

PURPOSE: The study examines changes in students' self-assessment of their general communication (GC) and medical communication (MC) competencies, as well as perceptions of MC concepts. METHODS: Participants included 108 second year medical students enrolled at a Korean medical school studying an MC curriculum. It was divided into three sections, and participants responded to questionnaires before and after completing each section. To assess perceived GC and MC competency, items based on a 7-point Likert scale were employed; a single open-ended item was used to examine students' perceptions of MC. Statistical analysis was conducted to gauge GC and MC competency, whereas semantic network analysis was used to investigate students' perceptions of MC. RESULTS: Students perceived their GC competency to be higher than MC. Perceived MC competency differed significantly across the three sections, whereas no differences were found for GC. There were no statistically significant differences after completing the curriculum's second and third sections; however, the vocabulary students used to describe MC concepts became more scholarly and professional. In the semantic networks, the link structure between MC-related words decreased in linearity and looseness, becoming more complex and clustered. The words ‘information’ and ‘transfer’ proved integral to students' perceptions; likewise, ‘empathy’ and ‘communication’ became closely connected in a single community from two independent communities. CONCLUSION: This study differed from prior research by conducting an in-depth analysis of changes in students' perceptions of MC, and its findings can be used to guide curriculum development.

Analysis of Students' Reflective Journals on Medical Communication Role Plays / 의학교육논단

This study explores the phenomenon of learner reflection in writing. Sixty-nine reflection logs were submitted by students after medical interview role plays. Using thematic analysis methodology, the following three steps were carried out: (1) the entire contents of the logs were analyzed and coded, (2) the coded contents were reclassified and categorized into higher themes, and (3) all reflection logs were re-analyzed to derive the frequency according to their classifications. The learners’ reflection contents were classified into ‘preparation,’ ‘experience,’ and ‘future plan.’ The levels of reflection were ‘simple information and appreciation,’ ‘acquisition and application of knowledge,’ and ‘analysis and criticism.’ The types of reflection were identified only at the level of ‘analysis and criticism’ and could be classified into ‘relativization,’ ‘objectification,’ and ‘internalization.’ Students’ reflection levels were highest in the levels of ‘acquisition and application of knowledge’ (49.3%), and ‘analysis and criticism’ (37.7%). A total of 14.5% of the students showed ‘internalization.’ In order to enable internalized reflection at a critical level, instructional strategies to induce and promote reflection are needed.

Explanatory Study of Medical Students' Perception of Life Concept / 의학교육논단

This study surveyed 506 medical students on their perception of life concept using an open-ended questionnaire. A constant comparative analysis of participants' written responses was conducted. The results revealed 3 main types and several sub-types of life concept. The main types included: humanities & sociology type, scientific type, and humanities · sociology & science mixed type. The humanities & sociology type had 6 sub-types: religious values, ethical values, limited time, social characteristics, consciousness · spirit · soul, and mixed type. The scientific type had 4 sub-types as follows: respiration & metabolism, genetic & reproduction, homeostasis & emergent property, and mixed type. The most prevalent type was the perception that life concept, ethical values in humanities & sociology type. The understanding of the concept of life is essential to medical students' learning and improvement of professional competence. These results may suggest a meaningful direction for medical education regarding the concept of life.

Trends of research articles in the Korean Journal of Medical Education by social network analysis / 한국의학교육

PURPOSE: This aim of this study is to examine trends in medical education research in the Korean Journal of Medical Education (KJME) and suggest improvements for medical education research. METHODS: The main variables were keywords from research papers that were published in KJME. Abstracts of papers (n=499) that were published from 1991 through 2015 were analyzed by social network analysis (NetMiner 4.0) a common research method for trends in academic subjects. RESULTS: The most central keywords were "medical education," "clinical competence," "medical student," and "curriculum." After introduction into graduate medical school, newly appearing keywords were "professional behavior," "medical humanities," "communication," and "physician-patient relation." Based on these results, we generated a schematic of the network, in which the five groups before introduction to graduate medical school expanded to nine groups after introduction. CONCLUSION: Medical education research has been improving qualitatively and quantitatively, and research subjects have been expanded, subdivided, and specific. While KJME has encompassed medical education studies comprehensively, studies on medical students have risen in number. Thus, the studies that are published in KJME were consistent with the direction of journal and a new study on the changes in medical education is being conducted.

Perceptual comparison of the "good doctor" image between faculty and students in medical school / 한국의학교육

PURPOSE: The purpose of this study is to analyze the differences in the perception of the "good doctor" image between faculty and students, based on the competencies of the "Korean doctor's role." METHODS: The study sample comprised 418 students and 49 faculty members in medical school. They were asked to draw images of a "good doctor," and the competencies were then analyzed using the Draw-A-Scientist test and the social network program Netminer 4.0. RESULTS: Of the competency areas, "communication and collaboration with patient" and "medical knowledge and clinical skills" were the most frequently expressed, and "education and research," "professionalism," and "social accountability" were less commonly expressed. Images of a good doctor by the faculty focused on competencies that were directly related to current clinical doctors. Conversely, those by the students expressed various competencies equally. CONCLUSION: We have provided basic data for faculties and schools to plan various education strategies to help students establish the image of a good doctor and develop the necessary competencies as physicians.

Relationships among emotional intelligence, ego-resilience, coping efficacy, and academic stress in medical students / 한국의학교육

PURPOSE: The purpose of this study was to identify the causal relationship between emotional intelligence, ego-resilience, coping efficacy, and academic stress. METHODS: Participants were 424 medical students from four medical schools in Korea. We examined their emotional intelligence, ego-resilience, coping efficacy, and academic stress using a t-test, an analysis of variance, correlational analysis, and path analysis. RESULTS: First- and second-year students scored higher on academic stress than did those from third- and fourth-year students. Further, coping efficacy mediated the relationships between emotional intelligence, ego-resilience, and academic stress. Academic stress was directly influenced by coping efficacy, and indirectly by emotional intelligence and ego-resilience. This showed that coping efficacy play an important role in academic stress. CONCLUSION: Our findings may help medical schools design educational programs to improve coping efficacy in students, and to reduce their academic stress.

The differences in self-efficacy in clinical performance between medical students and residents / 한국의학교육

PURPOSE: The purpose of this study was to compare the differences in self-efficacy in clinical performance (SECP) between medical students and residents. METHODS: A total of 267 medical students and 110 residents participated in a survey on SECP with regard to seven factors: knowledge acquisition and application, clinical reasoning, clinical skills, communication with patients, relationships with other health professionals, medical ethics, and self-development. The data were examined by multivariate analysis of variance. RESULTS: Residents had higher scores for clinical skills than students (F[1, 372]=8.919, p<0.01), whereas students scored significantly higher for communication with patients (F[1, 372]=26.779, p<0.001), relationships with other health professionals (F[1, 372]=12.807, p<0.001), medical ethics (F[1, 372]=40.136, p<0.001), and self-development (F[1, 372]=32.380, p<0.001). There were no differences between genders or specialties of residents. CONCLUSION: There are differences in SECP between students and residents. These results can guide the design of self-efficacy improvement programs.

The development and effects of a medical communication skills program for medical school students / 한국의학교육

PURPOSE: The purpose of the study is to develop education programs for improving medical school students' medical communication ability, and to provide basic information to help develop and operate medical communication education programs by analyzing the education programs and students satisfaction from the education effects. METHODS: The method was to survey 116 sophomores in C medical school in 2014 in order to research students' demands for the medical communication education, level differences of communication between before and after of the education, and students' satisfaction from the education program. Analysis of frequency, paired samples t-test, descriptive statistic analysis were used for the research. RESULTS: There were not only many students who did not get general communication educations before admission, but also many students who said they need medical communication education. On the whole, students' abilities of communication were improved. Building relationship, information gathering, sharing information, understanding one's perspectives factors was improved meaningfully in the statistics. However opening relationship, reach agreement, and providing closure were not improved meaningfully in the statistics. On the whole, the students were satisfied from the education programs. CONCLUSION: To develop education programs for medical communication ability, we need to construct the objectives of education and contents by researching students' demands and level of learning in communication area. Moreover we have to design curriculum to maintain the education effects consistently.

Development and validation of the medical student stress scale in Korea / 한국의학교육

PURPOSE: Medical students experience various stresses that arise in a special environment. However, there is no specific stress scale for medical students with regard to their environment in Korea. Therefore, in this study, we developed and confirmed the validity of a stress scale for medical students in Korea. METHODS: A draft version of the scale was developed on the basis of open-ended questionnaires from 97 medical students. The validity of the content of this scale was evaluated by three medical educationists. The scale was administered to 435 third and fourth grade medical students as the main survey. For our data, we performed an exploratory factor analysis and confirmatory factor analysis. We used Cronbach alpha index to determine internal consistency. RESULTS: Six factors with 40 items were extracted through the exploratory factor analysis: academic stress (9 items); clerkship stress (11 items); interpersonal stress (7 items); career stress (8 items); health-related stress (3 items); and financial stress (2 items). These factors showed a statistically significant correlation. The confirmatory factor analysis demonstrated a favorable RMSEA (0.053) and reasonable fit (CFI=0.847, TLI=0.833). Cronbach alpha values of the six factors ranged from 0.63 to 0.85. CONCLUSION: The medical student stress scale had a good model fit. It is a valid and reliable instrument in identifying stress in medical students and can be used in future studies. Also, the scale is expected to provide individual stress profiles for students to help them manage stress more effectively.

Difference Analysis of Study Achievement in Course Related to Anatomy by Personality Type / 체질인류학회지

The purpose of the study is to analyse difference of study achievement in course related to anatomy by personality type and to suggest application plan for anatomy education. We conducted a survey of 344 of the junior class in 2009, 2010, 2011 to get the results of MBTI personality type test and of courses related to anatomy And then, we analysed those results. As a result, personality type was similar to the distribution of the korean university students and the general public. But there was no difference in study achievements by personality type. We concluded that we should not predict study achievement by using personality type. And we should recognize personality types only as personality traits to utilize for student guidance, study guidance, effective teaching-learning method etc.

The Effect of Education Program of Cadaver Dissection for the Paramedical Students / 체질인류학회지

A purpose of the study is to provide basic information in order to find better ways for more effective cadaver dissection education by analyzing education effect on paramedical students after cadaver dissection. By using questionnaires composed of 12 questions, we have surveyed 1,041 paramedical students who participate in cadaver dissection in 2013 and analysed the results. The paramedical students are the department of nursing science, operation treatment, physical therapy, alternative medicine, clinical pathology, emergency rescue and dental hygienics. As a result, we have found that cadaver dissection makes students have more respect for human life and dignity, helps students learn anatomy and major. Furthermore, the degrees of satisfaction, interest, intention of afterward participation in cadaver dissection afterward are high. However, the degrees of intention of cadaver donations are low. We need to develop cadaver dissection programme customized for each majors in order to helps students have more respect for human life and dignity, more professionalism, more effective cadaver dissection education.

Basic research to guide alterations in an outcome-based curriculum / 한국의학교육

PURPOSE: The purpose of this study is to provide basic information that can be used to guide alterations in an outcome-based curriculum by analyzing the current curriculum. METHODS: A survey was administered to 103 juniors, 90 seniors, and 97 professors in Chonbuk National University Medical School on the importance of subgraduate and graduate outcomes, the appropriate curriculum to graduate, operational satisfaction, and self-judged achievement. RESULTS: There were significantly meaningful gaps in the importance of graduate and subgraduate outcomes. However, students considered other competencies, except for medical research, more important. The survey data on the appropriate curriculum for graduation and on the operational satisfaction with the curriculum show that overall reorganization of the curriculum is needed. Students felt that they achieved 50 to 60 of 100 with regard to graduate outcomes. Further, students recognize that there are no differences in achievement level between genders. But, they believe that seniors achieve more than juniors. CONCLUSION: A multilateral basic analysis can be useful to guide the improvement of an outcome-based curriculum to help graduates acquire the ability to provide basic medical treatment.

Medical student perception of physician values in practice by individual characteristics and preferred medical specialty field / 한국의학교육

PURPOSE: Medical students' values figure prominently in their choice of medical specialty; yet, little research has been performed on this topic. The purpose of this study was to analyze the differences in values according to medical students' individual characteristics (medical educational system, gender, and grade) and preferred medical specialty. METHODS: A total of 905 medical students participated in the study; 426 were graduate-entry medical students (GEMS), and 479 were undergraduate medical students (UMS). Further, 561 were male and 316 were female; 356 were in year 1, 219 were in year 2, 230 were in year 3, and 100 were in year 4. Students completed the Physician Values in Practice Scale (PVIPS). The PVIPS comprises six dimensions: autonomy, management, prestige, service, lifestyle, and scholarly pursuits. The data were analyzed by t-test and analysis of variance. RESULTS: GEMS had higher scores for service, management, and scholarly pursuits than UMS. Males had higher scores for prestige, lifestyle, and management, whereas female scored higher on service and scholarly pursuits. Higher grade was associated with increased scores for prestige, lifestyle, and management. The differences in lifestyle and scholarly pursuits were significant between preferred specialties. Students in support specialties scored significantly higher on lifestyle. With regard to scholarly pursuits, basic science specialties scored significantly higher than other specialties. CONCLUSION: There were significant differences in PVIPS according to individual characteristics and preferred medical specialty. This result could be useful in developing a medical specialty choice program for medical students.

Analysis of the Relationship between Students' Seating Preferences and Academic Achievement in Medical School / 한국의학교육

PURPOSE: This study aimed to explore the relationship between students' seating preferences and academic achievement in medical school. METHODS: The subjects of this study were 109 second-year students in C medical school. The pattern of seat selection of 109 students was surveyed by participant observation for 48 days, and a questionnaire was administered to determine the factors that were considered by students. Using SPSS version 12.0, we analyzed the factors that students considered with regard to seat selection and seat preference and the frequency of seat movements between areas. We performed one-way ANOVA to analyze the differences in academic achievement between students who moved seats versus those who did not. RESULTS: The most common reasons for seat selection were to focus better on the lecture (60 students), to focus better on lecture, and to feel familiar with the same seat (60 students). Students' preferred seats were in rows A4, A7, A5, and A3 (in descending order), which are primarily the central sections, and columns B15, B1, B14, B19 (in descending order), which are primarily both ends of the division. The difference in academic achievement between students who moved seats and those who did not was not significant (p>0.05). Among students who did not move seats, the difference in academic achievement between 9 seating areas was not significant in 6 subjects (p>0.05). CONCLUSION: The results of this study suggest that we should reconsider a professor's general perception regarding academic achievement according to seat location.